Sex differences in susceptibility to etiologic factors for peripheral atherosclerosis: Importance of plasma fibrinogen and blood viscosity

F. G. R. Fowkes, J. P. Pell, P. T. Donnan, E. Housley, G. D. O. Lowe, R. A. Riemersma, R. J. Prescott

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67 Citations (Scopus)


Cardiovascular risk factors in men, such as cigarette smoking, hypercholesterolemia, and hypertension, also increase risk in women, but the relative susceptibility to risk factors between the sexes is not established. Our aim was to investigate a wide range of possible etiologic factors in a single population study and identify those that were more strongly related to peripheral atherosclerosis in men or women. We studied personal factors (age and social class), lifestyle factors (smoking, exercise, alcohol intake, and dietary nutrients), and intermediary factors (obesity, diabetes, serum lipids, coagulation, and rheological factors). In the Edinburgh Artery Study in 1988 we measured cardiovascular risk factors in a random population sample of 1592 men and women aged 55 to 74 years. The ankle-brachial pressure index (ABPI), which is inversely related to the degree of peripheral atherosclerosis, was assessed in each subject. Lifetime cigarette smoking was correlated with a lower ABPI equally in men and women (r=-.27, P<.001). Dietary nutrients and alcohol intake were not related differently between the sexes with ABPI. However, recall of strenuous and moderate leisure time exercise during the age range of 35 to 45 years was related more strongly to a higher ABPI in men than in women (P<.05). Plasma fibrinogen, plasma viscosity, and blood viscosity were the only intermediary factors that had stronger univariate correlations with lower ABPI in men than in women. On multivariate analysis, the sex differences persisted for plasma fibrinogen (P<.05) and blood viscosity (P<.001); high-density lipoprotein cholesterol was related to ABPI in men only (sex difference, P<.1). We conclude that most lifestyle and intermediary factors were not related differently in men and women to peripheral atherosclerosis, but elevations in plasma fibrinogen and blood viscosity were each associated with a greater risk of disease in men.

Original languageEnglish
Pages (from-to)862-868
Number of pages7
JournalArteriosclerosis and Thrombosis
Issue number6
Publication statusPublished - Jun 1994


  • coagulation
  • epidemiology
  • gender
  • peripheral atherosclerosis
  • risk factors
  • viscosity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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